Neurology

Question 1

A patient presents with a headache she describes as the “worse headache of her life” Patient is photophobic and seems to be in a state of delirium. What is your leading diagnosis?

Answer 1

Subarachnoid hemorrhage

Question 2

What is the mechanism of a Subarachnoid hemorrhage?

Answer 2

MC: Berry aneurysm rupture; AVM

Question 3

A patient presents with a headache she describes as the “worse headache of her life” Patient is photophobic and seems to be in a state of delirium. Subarachnoid hemorrhage is suspected. What is the next step in evaluating this patient?

Answer 3

CT scan preferred first

If CT is negative, do an LP

Question 4

A patient presents with a headache she describes as the “worse headache of her life” Patient is photophobic and seems to be in a state of delirium. Subarachnoid hemorrhage is suspected. What is the best management for this patient?

Answer 4

Supportive: 
bed rest
stool softeners
lower ICP 
Surgical coiling or clipping
\+/- lower BP gradually (Nicardipine* ; Nimpdipine; Labetolol)

Question 5

A patient presents with a headache she describes as the “worse headache of her life” Patient is photophobic and seems to be in a state of delirium. Subarachnoid hemorrhage is suspected. CT scan was unremarkable. LP is highly suggestive of subarachnoid hemorrhage. What would this LP look like?

Answer 5

Xanthrochromia (RBCs) 
Increased CSF (ICP) pressure

Question 6

A patient presents with a headache she describes as the “worse headache of her life” Patient is photophobic and seems to be in a state of delirium. Subarachnoid hemorrhage is suspected. CT scan was unremarkable. LP is highly suggestive of subarachnoid hemorrhage. What is the next step in evaluating/managing this patient?

Answer 6

4 vessel angiography (after confirmed SAH)